Clinical Review

What we’ve learned from 2 decades’ experience with the LNG-IUS

OBG Manag. 2011 February;23(2):30-35

References

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OBG Management: You were coauthor of a study on consecutive use of the system, were you not? What did you find?

Dr. Heikinheimo: We enrolled 204 women 23 to 45 years old who had used an LNG-IUS for 4 years and 3 to 9 months and who opted to have a second system inserted at the time the first one was removed. Overall, we found the LNG-IUS to be well tolerated and highly acceptable among the women. In addition, the pattern of reduced menstrual bleeding that had developed during use of the first LNG-IUS continued after it was replaced; in some cases, it was even further reduced.¹⁵

Removal of the previous system and insertion of a new one at the same visit ensures that the initial irregular spotting period, which is typical of the first months after LNG-IUS insertion, does not recur in consecutive use. The rate of overall satisfaction with the system, assessed at the end of the first year after insertion of the second LNG-IUS, was high—93%. The women who were amenorrheic were most satisfied (100%).

The view from Scandinavia

OBG Management: As you noted earlier, the LNG-IUS has been widely used in Finland and Sweden for 20 years now. What else have we learned about the benefits and risks of the system from that long experience?

Dr. Heikinheimo: More and more women are asking for a bleeding-free contraceptive method! Also, the widespread use of the LNG-IUS has had an important impact on the entire specialty of obstetrics and gynecology. Because women are happy with the high contraceptive efficacy and reduced uterine bleeding, there has been a marked reduction in female sterilization. Similarly, the number of hysterectomies performed for benign causes has decreased by 40% over the past 10 years. These figures also translate into effective use of the surgical ward.

OBG Management: What other features of the LNG-IUS are worth mentioning here?

Dr. Heikinheimo: Besides the conventional users of intrauterine contraception—married parous women—nulliparous women are increasingly using the LNG-IUS.¹⁶ Young, highly fertile women need effective contraception that does not need to be remembered on a daily basis.

There is also an increasing number of publications describing the use of the LNG-IUS in women with various pre-existing conditions, such as insulin-dependent diabetes, HIV infection, and inherited bleeding disorders, as well as in institutionalized women. It is reassuring to see that the benefits of the LNG-IUS—safety, high contraceptive efficacy, and markedly reduced uterine bleeding—are also apparent in these women. I’m convinced that there are still several additional subgroups of women who will benefit from use of the LNG-IUS.

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